Background:
The Illinois Department of Healthcare and Family Services (HFS) is the single state agency responsible for the administration of Title XIX, Title XXI and All Kids (affordable health insurance coverage for all uninsured children). HFS covers approximately 49% of Illinois births, with 10% born LBW. HFS covers parents or caretaker relatives with family income up to 185% of poverty.
Two-thirds of HFS pregnant women had a prior pregnancy; an estimated 61% of the pregnancies were unintended; and a significant number of women have one or more risk factors, including prior prematurity (8%-10%), fetal loss, hypertension (3%), renal disease, diabetes (2%) and asthma (7%). Many enrolled women of childbearing age suffer from chronic conditions, e.g., in 2002, approximately 6% were diagnosed with asthma; 50% were overweight or obese; 3% had cardiac disease; 3% were hypertensive; and 9% had diabetes.

Objectives:
To discuss creative strategies and policy changes that Illinois Medicaid has or will employ to promote preconception and interconception care and thereby contribute to improved health and birth outcomes.

Methods:
n/a

Results:
HFS' initiatives are as follows:
• Implementing the PCCM model to promote/provide a medical home
• Allowing adult preventive office visits (effective July 1, 2007)
• Encouraging risk assessments, providing separate reimbursement
• Piloting a preconception risk screening tool
• Implementing a family planning waiver program, covering folic acid and multivitamins, at state expense
• Operating a perinatal depression initiative that includes risk assessment, provider consultation services, provider training, 24-hour crisis hotline, and development of statewide referral and treatment resources
• Working with private foundations and Title V to pilot an interconceptional model in certain high-risk areas
• Developing requirements for the content of preconception and interconceptional visits
• Entering into public/private partnerships to test best practice strategies and drive policy decisions
• Applying predictive analytics to claims data in an effort to identify women at risk for a poor birth outcome and provide interventions prior to the next pregnancy

Conclusion and implications for practice:
Data from each of these initiatives will allow Illinois to better use scarce resources to improve women's health and birth outcomes by providing the services and interventions that are most effective.